Hemorrhoids have been classified in the two main varieties: external and internal.
External Hemorrhoid symptomsIn their most simple form, they may be present without giving rise to any symptoms and are usually unobserved until one of the various complications arises.
When symptoms are present, they are commonly described by the patient as a feeling of fullness, or a heaviness in the region of the anal margin.
Occasionally there is itching (pruritis) which is never intense unless followed by infection.
They are covered with skin which is unchanged in color and are soft swelling shich can be made to disappear on pressure. They are situated at the edge of the anal orifice.
When inflamed, there is acute pain which is more intense during defecation. The hemorrhoidal mass then is of a violet or purplish color, inceased in size, is firm and cannot be made to disappear on pressure.
There is an increase in local temperature and in some cases, a spasmodic contraction of the sphincter ani muscle.
Pain is severe in infected hemorrhoids, even in the small type. This may be readily expained by the rich sensory nerve supply in the lower part of the anal canal and margin of the anus.
When thrombosis occurs, there is a history of a sudden acute pain, commonly first noticed during defecation or straining which frequently disappears after the completion of the act. This is followed by a contant pain of more or less severity, due to the pressure on the nerve endings, and depending upon the extent of the swelling which disappears as the swelling subsides.
A thrombosed external hemorrhoid is usually self-limited and may terminate by resolution, leaving a skin tab or it may end by rupture on the skin surface and the evacuation of the clot, with more less hemorrhage. If followed by infection, it may be the direct cause of a marginal abcess. When the attack terminates by resolution, there is a tendency for it to recur.
Connective Tissue Hemorrhoids - Skin tabs - Sentinel Piles SymptomsIf uncomplicated, they cause no symptoms except in the toilet of the part, which incidentally can often be prevented by careful cleansing of the parts after defecation with some soft, material (wet wipes are fine as well). When complicated by infection, or fissure-in-ano, there is .
In extreme and severe cases, there is loss appetite, coated tongue, and digestive disturbancs, insomnia, fast pulse, slight rise of temperature and nervousness.
Internal Hemorrhoids SymptomsThe chief symptoms of internal hemorrhoids according to the frequency of occurence, are:
3. Itching ( pruritis )
4. Mental depression
Bleeding hemorrhoidsBleeding is the earliest and most common of symptoms and generally occurs during the act of defecation. It varies in a mount from the streaking of the stool in mild cases, to such an extent in extreme cases, that the patient becomes weak from the loss of blood.
The amount of blood lost each time does not often exceed a few teaspoonfuls, is of a dark color, and venous in origin. Occasionally, it is bright red or arterial in origin. In some cases spurting from the parts may be observed.
When a moderate degree of hemorrhage occurs at each and every defaction over a long period of time, anemia and cachexia follow which might be easily attributed to some other malady. It is surprising to note how rapidly the cachexia and anemia disappear when the hemorrhage has been controlled.
In cases of internal hemorrhoids of long standing with marked prolapse, the bleeding has a tendency to decrease because of the mucous membrane becoming thickened and less vascular.
Prolaped Protruding PilesThis cannot occur until the hemorrhoids have formed definte and distinct masses, and therefore it is generally a late symptom. Other than bleeding, it is the chief that causes the patient to seek medical advice.
At first it occurs only defecation following drastic purgatives or diarrhea, and returns spontaneously after the act. As time goes on, the protruding parts cease to return; the patient acquires the habit of reducing them by gentle pressure after each act of the bowels. In some cases of years' standing, the patient becomes a past master of this art and aids it by certain muscular movements and manipulation of the buttocks.
The protruding parts tend to become pedunculated and may prolapse on the slightest exertion when the patient walks, lifts, sneezes or coughs.
Unless the sphincter ani muscle is relaxed, they are likely te become strangulated at any time and this may be followed by thrombosis or by gangrene. In prolapsed piles there is usually a slight discharge of mucus which is sufficient in amount at times to keep the skin damp, soil the clothing, and cause itching.
Itching ( Pruritis )Itching is not a common symptom, but in many cases it may be the first sign noticed by the patient. It is to be remembered that hemorrhoids are only one of the numerous causes of pruritis.
In protruding internal hemorrhoids which prevent the sphincter ani muscle from entirely closing, the presense of mucus from the exposed mucous surface moistens the skin around the anus and is the cause of the irritation.
A proof that the itching is really caused by the discharge of the protruding pile, is that as soon as the pile disappers as result of treatment, the itching ceases. When this doen not occur, some other cause should be sought and treatment instituted accordingly.
Mental DepressionHemorrhoids can make people feel mentally depressed. It is often observed that as soon the patient is relieved from hemorrhoids an entire change in mental attitude of the patient occurs. His state of gloom was changed to a brighter and more optimistic view of life in general.
PainThis is a rare symptom of internal hemorrhoid unless complicated by infection or strangulation. Internal hemorrhoids may be present for year with constant bleeding and protruding of the parts, and give rise to nothing more than the sensation of weight and dragging in the region of the rectum.
It has been stated that pain from piles may be referred to different parts of the anatomy; the most common being the bladder and testicles in the male, and the uturus and ovaries in the female. As well as sciatica, pain in the back, so-called lumbago.
Where pain is complained of the chief symptom of the patient, and on examination you do not find protruding strangulated internal hemorrhoids, the pain is probably from some other cause. The common causes of pain are anal fissures, cryptitis, abscess, proctitis, and thrombosed external hemorrhoids.
Anatomy anus and rectum
Causes of hemorrhoids
Prevention of hemorrhoids
What are hemorrhoids
Types of hemorrhoids